HomeMy WebLinkAboutBRN2008-00051 - BRN Application - 4/24/2008 PERMIT NO.
MASON COUNTY BURN PERMIT APPLICATION-]�
426 W. Cedar• P.O. Box 186, Shelton, WA 98584 UL- ZLY,�-CboS)
Shelton (360) 427-9670 • Belfair(360) 275-4467 • Elma (360) 482-5269 •www.co.mason.wa.us
APPLICANT IN OR ATION CONTRACTOR INFOR T ON
Owner GI ,L-fv�'n Company Name +-►
Mail' Address Mailin Address
City r" Stat 114 'p Code528' City State Zip Code
Phon 'fl Other FhI&D-1„?u7'55-I la Phon b 74F Other Ph.
Lien/Title Holder Contractor Reg. # #060= xr)
Email Address � '.-� E Mail Address
Drivers Lic. DOB Drivers Li DOB o?d
PARCEL INFORMATION - 12 Digit PawW 1 Fire District
0 Is property flagged or addressed prior to inspection? No
Site Address(Please include street name, street number and city) Q—
Directions to site - S-
"
Will timber be cut and sold in parce repara on?Yes N
Is property within 200'of Saltwater�Lake River/Creek AZo Pond
Wetland �l Seasonal Runoff�EQ Stream Slopes or Bluffs > 15% i((//UU
The person in charge of the fire may be liable for the cost of fire supression if the fire gets out of control or if it becomes
necessary to extinguish the fire as a result of enforcement action.
Open burning shall be prohibited during any period of impaired air quality as designated by the Olympic Region Clean
Air Agency,or during extreme fire danger due to dry weather conditions as designated by the Mason County Fire
Marshal's Office.Information hotline(360)427-7799
Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action? Yes/ o
Burning is authorized subject to the following conditions:
Klid permit must be on site while burning
ohibited materials.the following must not be burned:
arbage,dead animals,asphalt, petroleum products, paints, rubber products, plastics, paper,cardboard,treated wood,
co strucbon/demolition debris, metal,or any substance(other than natural vegetation)that normally releases toxic
fissions,dense smoke,or obnoxious odors when burned.
I materials must originate from the property on which the burning is to occur.
The fire must not create a nuisance from smoke,obscure visibility on public roads and highways,or endanger life and property.
ximum pile size is twenty(20)feet in diameter,a minimum ten(10)feet firebreak must be constructed around each pile.
Pch pile must be at least one hundred(100)feet from any structure,at least fifty(50)feet from standing timber.
not burn ifwind is blowing more than seven(7)miles per hour.
not burn if wind is blowing from (direction)
esponsible adult and equipment shall be required to be on site and in 5 ttendance a e fir hile burning.
n site water required: AYes [3 No cWAA- 6 #-osrT- dA✓ S/�!�
RrovideEXCAVATOR/DOZER with afire extinguisher at the site with a qualified oper
ovide 24 hour fire watch.
ire must be completely extinguished within three(3)days after ignitio
Fan required
0 Other
0 Upon completion of above conditions,applicant must c (360)427-9670 Ext.459 fo ' spection prior to burning
OWNER/CONTRACTOR Acknowledges submission of inaccurate inf n m e op order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,o ers legal representative,or the contractor. I further declare that I
am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the neces-
sary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the
application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,
represents that the information provided is accurate and grants employees of Mason County access to the above described property for review and
inspection. This permit/application becomes null and void if work is not completed within 30 days. Permit includes two (2) inspections maximum,
addi' na i pet will ire a fee of sixty four(64)dollars per inspection.
)62
Date: ykr
caner wners Representative/Contractor indicate which one
FOR CIVIM- ClAA USE BEYOND T INT Accepted by Date 44-,4Y-00
lDEPARTME T L RgVI PROVE DENIED NOTES
FireMarshal p `-t:)
FEES
Burn Permit Fee Site Inspection Violation Fee
State Fee Pre-Paid at Submittal Other
TOTAL FEES